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Xu C, Zhang Y, Peng Y, Zhao R, Xie M, Fang L, Lv Q. Live Biplane Transesophageal Echocardiography Improves Detection of Right-to-Left Shunts Through Patent Foramen Ovale. J Am Soc Echocardiogr 2024; 37:643-645. [PMID: 38325762 DOI: 10.1016/j.echo.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/19/2024] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Chunyan Xu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yongxing Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuan Peng
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Ruohan Zhao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Lingyun Fang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qing Lv
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Badea RȘ, Mihăilă-Bâldea S, Ribigan A, Negrilă A, Grecu N, Marinescu AN, Antochi F, Tiu C, Vinereanu D, Popescu BO. PFO-spectrum disorder: two different cerebrovascular diseases in patients with PFO as detected by AI brain imaging software. Front Neurol 2024; 15:1357348. [PMID: 38440117 PMCID: PMC10909929 DOI: 10.3389/fneur.2024.1357348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/06/2024] [Indexed: 03/06/2024] Open
Abstract
Background Patent foramen ovale (PFO) is a prevalent cardiac remnant of fetal anatomy that may pose a risk factor for stroke in some patients, while others can present with asymptomatic white matter (WM) lesions. The current study aimed to test the hypothesis that patients with a PFO who have a history of stroke or transient ischemic attack, compared to those without such a history, have a different burden and distribution of cerebral WM hyperintensities. Additionally, we tested the association between PFO morphological characteristics and severity of shunt, and their impact on the occurrence of ischemic cerebral vascular events and on the burden of cerebral WM lesions. Patients and methods Retrospective, case-control study that included patients with PFO confirmed by transesophageal echocardiography. Right-to-left shunt size was assessed using transcranial Doppler ultrasound. Cerebral MRIs were analyzed for all participants using the semi-automated Quantib NDTM software for the objective quantification of WM lesions. WM lesions volume was compared between patients with and without a history of stroke. Additionally, the anatomical characteristics of PFOs were assessed to explore their relation to stroke occurrence and WM lesions volume. Results Of the initial 264 patients diagnosed with PFO, 67 met the inclusion criteria and were included in the analysis. Of them, 62% had a history of PFO-related stroke/TIA. Overall burden of WM lesions, including stroke volume, was not significantly different (p = 0.103). However, after excluding stroke volume, WM lesions volume was significantly higher in patients without stroke (0.27 cm3, IQR 0.03-0.60) compared to those with stroke/TIA (0.08 cm3, IQR 0.02-0.18), p = 0.019. Patients with a history of PFO-related stroke/TIA had a tendency to larger PFO sizes by comparison to those without, in terms of length and height, and exhibited greater right-to-left shunt volumes. Discussion We suggest that PFO may be associated with the development of two distinct cerebrovascular conditions (stroke and "silent" WM lesions), each characterized by unique imaging patterns. Further studies are needed to identify better the "at-risk" PFOs and gain deeper insights into their clinical implications.
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Affiliation(s)
- Raluca Ștefania Badea
- Department of Neurology, University and Emergency Hospital, Bucharest, Romania
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Sorina Mihăilă-Bâldea
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Department of Cardiology and Cardiovascular Surgery, University and Emergency Hospital, Bucharest, Romania
| | - Athena Ribigan
- Department of Neurology, University and Emergency Hospital, Bucharest, Romania
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Anca Negrilă
- Department of Neurology, University and Emergency Hospital, Bucharest, Romania
| | - Nicolae Grecu
- Department of Neurology, University and Emergency Hospital, Bucharest, Romania
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | | | - Florina Antochi
- Department of Neurology, University and Emergency Hospital, Bucharest, Romania
| | - Cristina Tiu
- Department of Neurology, University and Emergency Hospital, Bucharest, Romania
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Dragos Vinereanu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Department of Cardiology and Cardiovascular Surgery, University and Emergency Hospital, Bucharest, Romania
| | - Bogdan Ovidiu Popescu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Department of Neurology, Colentina Clinical Hospital, Bucharest, Romania
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Farjat-Pasos JI, Chamorro A, Lanthier S, Robichaud M, Mengi S, Houde C, Rodés-Cabau J. Cerebrovascular Events in Older Patients With Patent Foramen Ovale: Current Status and Future Perspectives. J Stroke 2023; 25:338-349. [PMID: 37813671 PMCID: PMC10574307 DOI: 10.5853/jos.2023.01599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 10/11/2023] Open
Abstract
Patent foramen ovale (PFO) closure, along with medical therapy, has emerged as the therapeutic gold standard in younger (<60-year-old) patients with a PFO-related stroke for preventing recurrent events. However, PFO management guidelines lack definite recommendations for older (>60 years) patients with a PFO-related cerebrovascular event, a complex group of patients who were mostly excluded from PFO closure clinical trials. Nevertheless, several studies have shown a higher prevalence of PFO among older patients with cryptogenic stroke, and its presence has been associated with an increased risk of recurrent events. Furthermore, older patients exhibit a higher prevalence of high-risk PFO anatomical features, present inherent age-related risk factors that might increase the risk of paradoxical embolism through a PFO, and have a higher incidence of ischemic events after a PFO-related event. Additionally, observational studies have shown the safety and preliminary efficacy of PFO closure in older PFO-related stroke patients. Yet, higher rates of recurrent cerebrovascular events and new-onset atrial fibrillation were observed in some studies among older patients compared to their younger counterparts. After careful case-by-case evaluation, including the assessment of hidden potential cardioembolic sources of a cryptogenic stroke other than PFO, transcatheter PFO closure might be a safe and effective therapeutic option for preventing recurrent thromboembolic events in patients >60 years with a high-risk PFO-associated stroke. Ongoing trials will provide important insights into the role of PFO closure in the elderly population.
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Affiliation(s)
- Julio I. Farjat-Pasos
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
| | - Angel Chamorro
- Department of Neuroscience, Hospital Clinic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Sylvain Lanthier
- Neurovascular Program and Research Center, Montreal Sacre Coeur Hospital; Montreal, Canada
| | - Mathieu Robichaud
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
| | - Siddhartha Mengi
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
| | - Christine Houde
- Department of Pediatric Cardiology, Laval University Hospital Center, Quebec City, Canada
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
- Department of Research & Innovation, Clínic Barcelona, Barcelona, Spain
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Song JK. Pearls and Pitfalls in the Transesophageal Echocardiographic Diagnosis of Patent Foramen Ovale. J Am Soc Echocardiogr 2023; 36:895-905.e3. [PMID: 37196905 DOI: 10.1016/j.echo.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/19/2023]
Abstract
Large randomized controlled trials have shown the benefits of percutaneous closure of patent foramen ovale (PFO) in patients with cryptogenic stroke and PFO. Recent studies have highlighted the clinical significance and prognostic implication of various anatomical features of PFO and the adjacent atrial septum, such as atrial septal aneurysm (ASA), PFO size, large shunt, and hypermobility. Transthoracic echocardiography with contrast study is used for the indirect diagnosis of PFO, as it reveals the passage of the contrast into the left atrium. In contrast, transesophageal echocardiography (TEE) offers a direct demonstration of PFO by measuring its size using the maximum separation distance between the septum primum and septum secundum. Furthermore, TEE enables the acquisition of detailed anatomical features of the adjacent atrial septum including ASA, hypermobility, and PFO tunnel length, which carry significant prognostic implications. Transesophageal echocardiography also facilitates the diagnosis of pulmonary arteriovenous malformation, a relatively rare cause of paradoxical embolism. This review provides evidence for supporting TEE as a useful screening test for patients with cryptogenic stroke to identify suitable candidates for percutaneous device closure of PFO. Additionally, cardiac imaging specialists with proficiency in comprehensive TEE examination should be part of the heart-brain team for proper evaluation of and decision-making in patients with cryptogenic stroke.
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Affiliation(s)
- Jae-Kwan Song
- Professor of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Rigatelli G, Zuin M, Bilato C. Atrial septal aneurysm contribution to the risk of cryptogenic stroke in patients with patent foramen ovale: A brief updated systematic review and meta-analysis. Trends Cardiovasc Med 2023; 33:329-333. [PMID: 35181471 DOI: 10.1016/j.tcm.2022.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/11/2022] [Accepted: 02/11/2022] [Indexed: 10/19/2022]
Abstract
Atrial septal aneurysms (ASA) play an important role in cryptogenic stroke (CS) in patients with patent foramen ovale (PFO) but its contribution remains still not fully clarified in current literature. We sought to evaluate the contribution of ASA to the risk of CS in PFO patients based on studies published so far by means of a systematic review and metanalysis. A literature search, based on PubMed, Google Scholar and EMBASE databases, was performed to locate articles, published English language between 2000 and 2021, analysing the relationship between ASA and CS. The final research was conducted in September 2021. A total of 577 articles were retrieved after excluding duplicates. The initial screening excluded 215 articles because they did not meet inclusion criteria, leaving 362 articles to assess for eligibility. Subsequently, after evaluation of the full-text articles, 354 were excluded and 8 investigations met the inclusion criteria. Overall, 822 patients (mean age 48.3 years) were enrolled in the reviewed manuscripts with a prevalence of males of 48.7% and a normal distribution of the classical cardiovascular risk factors. ASA was present in 25.3% (208 subjects) of the patients enrolled, while the association of PFO+ASA was observed in 24.3% (200 subjects) of patients enrolled. PFO Patients with ASA were at higher risk of CS compared to those without (odd ratio: 3.38, 95% CI: 2.72-5.51, p<0.001, I2=4.3%,). The relative funnel plot did not show any evident asymmetry, confirming absence of publication bias. Our updated metanalysis enhances the importance of ASA contribution to stroke in patients with patent foramen ovale, being present in a third of patients with symptomatic PFO to whom it confers an additional odd ratio of 3.38.
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Affiliation(s)
- Gianluca Rigatelli
- Division of Cardiology, Department of Specialistic Medicine, Rovigo General Hospital, Rovigo, Italy.
| | - Marco Zuin
- Department of Morphology, Surgery & Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Claudio Bilato
- Division of Cardiology, Ospedale dell'Ovest Vicentino, Arzignano, Vicenza, Italia
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Molnár AÁ, Sánta A, Pásztor DT, Merkely B. Atrial Cardiomyopathy in Valvular Heart Disease: From Molecular Biology to Clinical Perspectives. Cells 2023; 12:1796. [PMID: 37443830 PMCID: PMC10340254 DOI: 10.3390/cells12131796] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
This review discusses the evolving topic of atrial cardiomyopathy concerning valvular heart disease. The pathogenesis of atrial cardiomyopathy involves multiple factors, such as valvular disease leading to atrial structural and functional remodeling due to pressure and volume overload. Atrial enlargement and dysfunction can trigger atrial tachyarrhythmia. The complex interaction between valvular disease and atrial cardiomyopathy creates a vicious cycle of aggravating atrial enlargement, dysfunction, and valvular disease severity. Furthermore, atrial remodeling and arrhythmia can predispose to atrial thrombus formation and stroke. The underlying pathomechanism of atrial myopathy involves molecular, cellular, and subcellular alterations resulting in chronic inflammation, atrial fibrosis, and electrophysiological changes. Atrial dysfunction has emerged as an essential determinant of outcomes in valvular disease and heart failure. Despite its predictive value, the detection of atrial fibrosis and dysfunction is challenging and is not included in the clinical routine. Transthoracic echocardiography and cardiac magnetic resonance imaging are the main diagnostic tools for atrial cardiomyopathy. Recently published data have revealed that both left atrial volumes and functional parameters are independent predictors of cardiovascular events in valvular disease. The integration of atrial function assessment in clinical practice might help in early cardiovascular risk estimation, promoting early therapeutic intervention in valvular disease.
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Liu X, Zhang Y, Xie H, Zeng H, Sun J, Su L, Li B, Xue X, Zhang Y. Change in patent foramen ovale height is associated with cryptogenic stroke and the construction of a morphology-based scoring system. Front Cardiovasc Med 2022; 9:1010947. [DOI: 10.3389/fcvm.2022.1010947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022] Open
Abstract
IntroductionCurrent guidelines recommended patent foramen ovale (PFO) occlusion as the preferred treatment for PFO-related cryptogenic stroke (CS); however, finding the causative foramen ovale remains challenging. This study aimed to identify predictors and establish a scoring system by assessing PFO morphology and stroke-related factors.MethodsBased on a prospective multicenter registered clinical trial, we compared data mainly derived from transesophageal echocardiography (TEE) and clinical history in patients with PFO-related CS and those without CS (non-CS) with incidental PFO. Subsequently, we explored independent predictors using logistic analysis, established a scoring system based on the results, and finally evaluated the scoring system using receiver operating characteristic (ROC) analysis and internal validation.Results75 patients with PFO-related CS and 147 non-CS patients were enrolled. Multivariate logistic analysis showed that the change in PFO height, large PFO, atrial septal aneurysm (ASA), and sustained right-to-left shunt (RLS) had independent relationships with CS. Based on the odds ratio value of each independent factor, a scoring system was built: change in PFO height ≥ 1.85 mm (3 points), large PFO (2 points), ASA (5 points), sustained RLS (2 points). 0–2 points correspond to low-risk PFO, 3–5 points medium-risk PFO, and 7–12 points high-risk PFO. ROC analysis showed an area under the curve of 0.80 to predict CS. The proportion of patients with CS is increasing based on these points.ConclusionsOur study screened out the change in PFO height as an independent predictor of CS. A simple and convenient scoring system can provide constructive guidance for identifying whether the PFO is causal and consequently selecting patients more likely to benefit from closure.
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Fordyce AM, Whalley GA, Coffey S, Wilson LC. Adjunct Methods for the Detection of Patent Foramen Ovale: The Contribution of Transcranial Doppler and the Valsalva Manoeuvre. Heart Lung Circ 2022; 31:1471-1481. [PMID: 36038470 DOI: 10.1016/j.hlc.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 07/14/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022]
Abstract
A patent foramen ovale (PFO) is present in 25% of the population. In some patients, especially those without traditional stroke risk factors and with no immediately apparent cause, a cryptogenic stroke may be caused by an embolus passing through the PFO to the systemic circulation. The identification, or indeed exclusion, of a PFO is sought in these patients, most commonly using contrast-enhanced transthoracic or transoesophageal echocardiography. Another method for detecting a PFO is transcranial Doppler, which allows the detection of PFO possibly without the need for an echo laboratory, and with arguably improved sensitivity. This review will focus on transcranial Doppler detection of PFO, with a brief summary of echocardiographic techniques and the use of ultrasound contrast agents, and the role of provocations to increase diagnostic accuracy, specifically the Valsalva manoeuvre. We discuss the phases alongside the direct and indirect signs of an adequate Valsalva manoeuvre.
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Affiliation(s)
- Andrew M Fordyce
- Department of Medicine, University of Otago, Dunedin, New Zealand. http://www.twitter.com/AFordyceOtago
| | - Gillian A Whalley
- Department of Medicine, University of Otago, Dunedin, New Zealand. http://www.twitter.com/GWhalleyPhD
| | - Sean Coffey
- Department of Medicine, University of Otago, Dunedin, New Zealand; Southern District Health Board, New Zealand. http://www.twitter.com/DrSeanCoffey
| | - Luke C Wilson
- Department of Medicine, University of Otago, Dunedin, New Zealand.
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Xu L, Zhou C, Pan X, Zhou J, Sun H, Xu T. Effect of ASA on the risk of cerebrovascular ischemic events in patients with PFO. Ann Clin Transl Neurol 2022; 9:1384-1391. [PMID: 35894517 PMCID: PMC9463951 DOI: 10.1002/acn3.51638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/17/2022] [Accepted: 07/14/2022] [Indexed: 12/20/2022] Open
Abstract
Background Whether atrial septal aneurysm (ASA) increases the risk of cerebrovascular ischemic events in patients with patent foramen ovale (PFO) remains controversial. Objective We constructed a detailed meta‐analysis to assess the effect of ASA on risk of cerebrovascular ischemic events in patients with PFO. Methods Randomized controlled trials (RCTs) and observational studies (cohort studies and case‐control studies) that compared PFO‐ASA against PFO alone were included. Pooled odds ratios (OR) estimates and 95% CI were calculated using the fixed‐effect and random‐effect models. Results Four RCTs and twelve observational studies (five cohort studies and seven case‐control studies) contributed to the meta‐analysis. The pooled results of case‐control studies showed that ASA increased the risk of cerebrovascular ischemic events in patients with PFO (fixed‐effect model: OR = 3.69; 95% CI: 2.67–5.09; p < 0.01, random‐effect model: OR = 3.63; 95% CI: 2.51–5.24; p < 0.01). However, poole results from RCTs (fixed‐effect model: OR = 1.24; 95% CI: 0.78–1.95; p = 0.36, random‐effect model: OR = 1.27; 95% CI: 0.78–2.08; p = 0.34) and cohort studies (fixed‐effect model: OR = 1.35; 95% CI: 0.81–2.23; p = 0.25, random‐effect model: OR = 1.40; 95% CI: 0.84–2.33; p = 0.20) found no evidence. Overall analysis showed that ASA increased the risk of cerebrovascular ischemic events (fixed‐effect model: OR = 2.30; 95% CI: 1.84–2.87; p < 0.01, random‐effect model: OR = 2.11; 95% CI: 1.48–3.01; p < 0.01). The sensitivity analysis confirmed the stability of all results. Conclusions Although case‐control studies support ASA to increase the risk of cerebrovascular ischemic events in patients with PFO, RCTs and cohort studies challenged the credibility. Further prospective studies are needed to confirm the effect of ASA on patients with PFO.
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Affiliation(s)
- Liang Xu
- Department of Ultrasound, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang, Hubei Province, China
| | - Chang Zhou
- Department of Ultrasound, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang, Hubei Province, China
| | - Xuemei Pan
- Department of Ultrasound, The Third People's Hospital of Yichang City, Yichang, Hubei Province, China
| | - Jun Zhou
- Department of Ultrasound, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang, Hubei Province, China
| | - Heng Sun
- Department of Ultrasound, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang, Hubei Province, China
| | - Tao Xu
- Department of Ultrasound, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang, Hubei Province, China
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Dudkiewicz D, Hołda MK. Interatrial septum as a possible source of thromboembolic events. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Sharifkazemi M, Rahnamun Z, Davarpasand T, Mirjalili T. Letter to the Editor Regarding the Article by Holda et al., Patent Foramen Ovale Channel Morphometric Characteristics Associated with Cryptogenic Stroke: The MorPFO Score. J Am Soc Echocardiogr 2022; 35:788. [DOI: 10.1016/j.echo.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/22/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
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